Provider Demographics
NPI:1497489223
Name:SMITH, JORDAN ALICE (PA-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ALICE
Other - Last Name:POWELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-673-3960
Mailing Address - Fax:609-451-5518
Practice Address - Street 1:131 ROUTE 70 STE 100B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9501
Practice Address - Country:US
Practice Address - Phone:856-673-3960
Practice Address - Fax:609-451-5518
Is Sole Proprietor?:No
Enumeration Date:2022-07-16
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00712100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant